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Ageed A, Khan M. Eliminating Trachoma in Africa: The Importance of Environmental Interventions. Cureus 2024; 16:e52358. [PMID: 38234389 PMCID: PMC10792353 DOI: 10.7759/cureus.52358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/19/2024] Open
Abstract
Subsequent to the failure of the World Health Organisation (WHO) of achieving their target to eliminate trachoma by the year 2020, the most effective strategy in eliminating trachoma must be re-examined to accomplish the new target of eradication by the year 2030. Whilst antibiotic therapy is a core foundation of this elimination strategy, another important factor is the state of the environmental conditions in trachoma endemic countries. This manuscript aimed to identify the impact of environmental improvement strategies on the prevalence of trachoma and the significance of environmental improvement alongside the use of antibiotic treatment to achieve trachoma elimination. Two independent literature searches were conducted up until the 5th of July 2021. Two main databases were used to carry out these literature searches, namely, Ovid EMBASE and Ovid MEDLINE. All of the relevant references were found using MeSH and free text terms. Key terms used were 'trachoma', 'water', 'sanitation', 'hygiene' and 'environmental Improvement'. The exclusion criteria included non-African-based studies, review papers, protocols and case reports. A total of 17 studies were included for this review. Living within a close range of a water source was significantly associated with reduced risk of trachoma infection. Water obtained from piped water sources was associated with the lowest rates of active trachoma. Studies on facial cleanliness evidenced a strong association with reduced prevalence of trachoma. Whilst the provision of latrine facilities found was significantly associated with reduced prevalence of trachoma, there was no significant difference between the use of private latrine facilities over communal latrine facilities. The use of repeated scheduled antibiotic treatments over single-use antibiotic distribution had a greater impact both short term and long term on the prevalence rates of trachoma. Nonetheless, prevalence rates increased again following the commencement of treatment. Mass antibiotic treatment has been proven to have a greater impact on lowering the prevalence of trachoma initially, but this impact is not sustainable due to the rise in prevalence rates following the completion of treatment. A holistic approach, therefore, must be implemented with evidence showing that an emphasis on longer-term environmental methods should be implemented to compliment antibiotic distribution. Prioritisation of specific interventional measures should be tailored according to local epidemiology; nonetheless, these measures form the backbone of a trachoma elimination strategy to eliminate trachoma by the year 2030.
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Affiliation(s)
- Ahmed Ageed
- Hospital Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Maaz Khan
- Medical Education, Royal Surrey County Hospital, Guildford, GBR
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Baayenda G, Mugume F, Mubangizi A, Turyaguma P, Tukahebwa EM, Byakika S, Kahwa B, Kusasira D, Bakhtiari A, Boyd S, Butcher R, Solomon AW, Binagwa B, Agunyo S, Osilo M, Crowley K, Thuo W, French M, Plunkett E, Mosher AW, Harding-Esch EM, Ngondi J. Baseline Prevalence of Trachoma in Refugee Settlements in Uganda: Results of 11 Population-based Surveys. Ophthalmic Epidemiol 2023; 30:580-590. [PMID: 34488539 PMCID: PMC10581675 DOI: 10.1080/09286586.2021.1961816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE There are several settlements in the Northern and Western Regions of Uganda serving refugees from South Sudan and Democratic Republic of Congo (DRC), respectively. Trachoma prevalence surveys were conducted in a number of those settlements with the aim of determining whether interventions for trachoma are required. METHODS An evaluation unit (EU) was defined as all refugee settlements in one district. Cross-sectional population-based trachoma prevalence survey methodologies designed to adhere to World Health Organization recommendations were deployed in 11 EUs to assess prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds. Household-level water, sanitation and hygiene coverage was also assessed in study populations. RESULTS A total of 40,892 people were examined across 11 EUs between 2018 and 2020. The prevalence of TF in 1-9-year-olds was <5% in all EUs surveyed. The prevalence of trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds was <0.2% in 5 out of 11 EUs surveyed and ≥0.2% in the remaining 6 EUs. A high proportion of households had improved water sources, but a low proportion had improved latrines or quickly (within a 30-minute return journey) accessible water sources. CONCLUSIONS Implementation of the antibiotic, facial cleanliness and environmental improvement components of the SAFE strategy is not needed for the purposes of trachoma's elimination as a public health problem in these refugee settlements; however, intervention with TT surgery is needed in six EUs. Since instability continues to drive displacement of people from South Sudan and DRC into Uganda, there is likely to be a high rate of new arrivals to the settlements over the coming years. These populations may therefore have trachoma surveillance needs that are distinct from the surrounding non-refugee communities.
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Affiliation(s)
| | | | | | | | | | | | - Binta Kahwa
- Kampala International University Medical School, Kampala, Uganda
| | - Darlson Kusasira
- Refugees Department, Office of the Prime Minister, Kampala, Uganda
| | | | - Sarah Boyd
- Task Force for Global Health, Atlanta, Georgia, USA
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | - Aryc W. Mosher
- United States Agency for International Development, Washington DC, USA
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Fornace KM, Senyonjo L, Martin DL, Gwyn S, Schmidt E, Agyemang D, Marfo B, Addy J, Mensah E, Solomon AW, Bailey R, Drakeley CJ, Pullan RL. Characterising spatial patterns of neglected tropical disease transmission using integrated sero-surveillance in Northern Ghana. PLoS Negl Trop Dis 2022; 16:e0010227. [PMID: 35259153 PMCID: PMC8932554 DOI: 10.1371/journal.pntd.0010227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/18/2022] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
As prevalence decreases in pre-elimination settings, identifying the spatial distribution of remaining infections to target control measures becomes increasingly challenging. By measuring multiple antibody responses indicative of past exposure to different pathogens, integrated serological surveys enable simultaneous characterisation of residual transmission of multiple pathogens.
Methodology/Principal findings
Here, we combine integrated serological surveys with geostatistical modelling and remote sensing-derived environmental data to estimate the spatial distribution of exposure to multiple diseases in children in Northern Ghana. The study utilised the trachoma surveillance survey platform (cross-sectional two-stage cluster-sampled surveys) to collect information on additional identified diseases at different stages of elimination with minimal additional cost. Geostatistical modelling of serological data allowed identification of areas with high probabilities of recent exposure to diseases of interest, including areas previously unknown to control programmes. We additionally demonstrate how serological surveys can be used to identify areas with exposure to multiple diseases and to prioritise areas with high uncertainty for future surveys. Modelled estimates of cluster-level prevalence were strongly correlated with more operationally feasible metrics of antibody responses.
Conclusions/Significance
This study demonstrates the potential of integrated serological surveillance to characterise spatial distributions of exposure to multiple pathogens in low transmission and elimination settings when the probability of detecting infections is low.
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Affiliation(s)
- Kimberly M. Fornace
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Laura Senyonjo
- Research Team, Sightsavers UK, Haywards Heath, United Kingdom
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elena Schmidt
- Research Team, Sightsavers UK, Haywards Heath, United Kingdom
| | | | - Benjamin Marfo
- Neglected Tropical Disease Team, Ghana Health Service, Accra, Ghana
| | - James Addy
- Neglected Tropical Disease Team, Ghana Health Service, Accra, Ghana
| | | | - Anthony W. Solomon
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Robin Bailey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris J. Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Senyonjo L, Addy J, Martin DL, Agyemang D, Yeboah-Manu D, Gwyn S, Marfo B, Asante-Poku A, Aboe A, Mensah E, Solomon AW, Bailey RL. Surveillance for peri-elimination trachoma recrudescence: Exploratory studies in Ghana. PLoS Negl Trop Dis 2021; 15:e0009744. [PMID: 34543293 PMCID: PMC8519445 DOI: 10.1371/journal.pntd.0009744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/15/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction To date, eleven countries have been validated as having eliminated trachoma as a public health problem, including Ghana in 2018. Surveillance for recrudescence is needed both pre- and post-validation but evidence-based guidance on appropriate strategies is lacking. We explored two potential surveillance strategies in Ghana. Methodology/principal findings Amongst randomly-selected communities enrolled in pre-validation on-going surveillance between 2011 and 2015, eight were identified as having had trachomatous-inflammation follicular (TF) prevalence ≥5% in children aged 1–9 years between 2012 and 2014. These eight were re-visited in 2015 and 2016 and neighbouring communities were also added (“TF trigger” investigations). Resident children aged 1–9 years were then examined for trachoma and had a conjunctival swab to test for Chlamydia trachomatis (Ct) and a dried blood spot (DBS) taken to test for anti-Pgp3 antibodies. These investigations identified at least one community with evidence of probable recent Ct ocular transmission. However, the approach likely lacks sufficient spatio-temporal power to be reliable. A post-validation surveillance strategy was also evaluated, this reviewed the ocular Ct infection and anti-Pgp3 seroprevalence data from the TF trigger investigations and from the pre-validation surveillance surveys in 2015 and 2016. Three communities identified as having ocular Ct infection >0% and anti-Pgp3 seroprevalence ≥15.0% were identified, and along with three linked communities, were followed-up as part of the surveillance strategy. An additional three communities with a seroprevalence ≥25.0% but no Ct infection were also followed up (“antibody and infection trigger” investigations). DBS were taken from all residents aged ≥1 year and ocular swabs from all children aged 1–9 years. There was evidence of transmission in the group of communities visited in one district (Zabzugu-Tatale). There was no or little evidence of continued transmission in other districts, suggesting previous infection identified was transient or potentially not true ocular Ct infection. Conclusions/significance There is evidence of heterogeneity in Ct transmission dynamics in northern Ghana, even 10 years after wide-scale MDA has stopped. There is added value in monitoring Ct infection and anti-Ct antibodies, using these indicators to interrogate past or present surveillance strategies. This can result in a deeper understanding of transmission dynamics and inform new post-validation surveillance strategies. Opportunities should be explored for integrating PCR and serological-based markers into surveys conducted in trachoma elimination settings. The goal for trachoma programmes is elimination of trachoma as a public health problem. This means that ongoing low-level eye-to-eye transmission of the causative bacterium, Chlamydia trachomatis (Ct), is acceptable. Countries need to implement a suitable surveillance system to identify any return to higher transmission levels. The best methodology for doing this is not known. We first explored the approach used by Ghana in its standard programme, which involved monitoring a limited number of randomly selected communities for evidence of active (inflammatory) trachoma visible in children’s eyes on examination by trained observers. Although this strategy led to identification of at least one community that had probably had recent Ct transmission, the approach is unlikely to consistently identify places where return to higher levels of transmission is a risk. We also explored using information on infection (detected in eye swabs) and antibodies to Ct (detected in the blood) to identify communities at risk. We found evidence of both persistent eye-to-eye Ct transmission and areas where infection was transient and has now gone away. We conclude that the use of infection and antibody data for surveillance of trachoma appears promising.
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Affiliation(s)
- Laura Senyonjo
- Research Team, Sightsavers, Haywards Heath, United Kingdom
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - James Addy
- Eye Health Department, Ghana Health Service, Accra, Ghana
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - Dorothy Yeboah-Manu
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Benjamin Marfo
- Neglected Tropical Diseases Division, Ghana Health Service, Accra, Ghana
| | - Adwoa Asante-Poku
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | | | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Amazigo UV, Leak SGA, Zoure HGM, Okoronkwo C, Diop Ly M, Isiyaku S, Crump A, Okeibunor JC, Boatin B. Community-directed distributors-The "foot soldiers" in the fight to control and eliminate neglected tropical diseases. PLoS Negl Trop Dis 2021; 15:e0009088. [PMID: 33661903 PMCID: PMC7932156 DOI: 10.1371/journal.pntd.0009088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The neglected tropical diseases (NTDs) affect hundreds of millions of people, predominantly in rural, often difficult-to-access areas, poorly served by national health services. Here, we review the contributions of 4.8 million community-directed distributors (CDDs) of medicines over 2 decades in 146,000 communities in 27 sub-Saharan African countries to control or eliminate onchocerciasis and lymphatic filariasis (LF). We examine their role in the control of other NTDs, malaria, HIV/AIDS interventions, immunisation campaigns, and support to overstretched health service personnel. We are of the opinion that CDDs as community selected, trained, and experienced "foot soldiers," some of whom were involved in the Ebola outbreak responses at the community level in Liberia, if retrained, can assist community leaders and support health workers (HWs) in the ongoing Coronavirus Disease 2019 (COVID-19) crisis. The review highlights the improved treatment coverage where there are women CDDs, the benefits and lessons from the work of CDDs, their long-term engagement, and the challenges they face in healthcare delivery. It underscores the value of utilising the CDD model for strong community engagement and recommends the model, with some review, to hasten the achievement of the NTD 2030 goal and assist the health system cope with evolving epidemics and other challenges. We propose that, based on the unprecedented progress made in the control of NTDs directly linked to community engagement and contributions of CDDs "foot soldiers," they deserve regional and global recognition. We also suggest that the World Health Organization (WHO) and other international stakeholders promote policy and guidance for countries to adapt this model for the elimination of NTDs and to strengthen national health services. This will enhance the accomplishment of some Sustainable Development Goals (SDGs) by 2030 in sub-Saharan Africa.
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Affiliation(s)
- Uche V. Amazigo
- African Programme for Onchocerciasis Control, World Health Organization, Enugu, Nigeria
| | - Stephen G. A. Leak
- African Programme for Onchocerciasis Control, World Health Organization, Macclesfield, Cheshire, United Kingdom
| | | | | | | | | | | | | | - Boakye Boatin
- Onchocerciasis Control Programme in West Africa, World Health Organization, Accra, Ghana
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Biritwum NK, de Souza DK, Asiedu O, Marfo B, Amazigo UV, Gyapong JO. Onchocerciasis control in Ghana (1974-2016). Parasit Vectors 2021; 14:3. [PMID: 33388081 PMCID: PMC7778817 DOI: 10.1186/s13071-020-04507-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background The control of onchocerciasis in Ghana started in 1974 under the auspices of the Onchocerciasis Control Programme (OCP). Between 1974 and 2002, a combination of approaches including vector control, mobile community ivermectin treatment, and community-directed treatment with ivermectin (CDTI) were employed. From 1997, CDTI became the main control strategy employed by the Ghana OCP (GOCP). This review was undertaken to assess the impact of the control interventions on onchocerciasis in Ghana between 1974 and 2016, since which time the focus has changed from control to elimination. Methods In this paper, we review programme data from 1974 to 2016 to assess the impact of control activities on prevalence indicators of onchocerciasis. This review includes an evaluation of CDTI implementation, microfilaria (Mf) prevalence assessments and rapid epidemiological mapping of onchocerciasis results. Results This review indicates that the control of onchocerciasis in Ghana has been very successful, with a significant decrease in the prevalence of infection from 69.13% [95% confidence interval) CI 60.24–78.01] in 1975 to 0.72% (95% CI 0.19–1.26) in 2015. Similarly, the mean community Mf load decreased from 14.48 MF/skin snip in 1975 to 0.07 MF/skin snip (95% CI 0.00–0.19) in 2015. Between 1997 and 2016, the therapeutic coverage increased from 58.50 to 83.80%, with nearly 100 million ivermectin tablets distributed. Conclusions Despite the significant reduction in the prevalence of onchocerciasis in Ghana, there are still communities with MF prevalence above 1%. As the focus of the GOCP has changed from the control of onchocerciasis to its elimination, both guidance and financial support are required to ensure that the latter goal is met.![]()
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Affiliation(s)
- Nana-Kwadwo Biritwum
- Neglected Tropical Diseases Programme, Ghana Health Service, Accra, Ghana. .,Bill & Melinda Gates Foundation, Seattle, USA.
| | - Dziedzom K de Souza
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon-Accra, Ghana
| | - Odame Asiedu
- Neglected Tropical Diseases Programme, Ghana Health Service, Accra, Ghana
| | - Benjamin Marfo
- Neglected Tropical Diseases Programme, Ghana Health Service, Accra, Ghana
| | - Uche Veronica Amazigo
- Pan-African Community Initiative on Education and Health (PACIEH), Enugu, Nigeria.,University of Nigeria, Nsukka, Enugu, Nigeria
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Solomon AW, Hooper PJ, Bangert M, Mwingira UJ, Bakhtiari A, Brady MA, Fitzpatrick C, Jones I, Kabona G, Kello AB, Millar T, Mosher AW, Ngondi JM, Nshala A, Renneker K, Rotondo LA, Stelmach R, Harding-Esch EM, Malecela MN. The Importance of Failure: How Doing Impact Surveys That Fail Saves Trachoma Programs Money. Am J Trop Med Hyg 2020; 103:2481-2487. [PMID: 33025878 PMCID: PMC7695084 DOI: 10.4269/ajtmh.20-0686] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Trachoma programs use annual antibiotic mass drug administration (MDA) in evaluation units (EUs) that generally encompass 100,000–250,000 people. After one, three, or five MDA rounds, programs undertake impact surveys. Where impact survey prevalence of trachomatous inflammation—follicular (TF) in 1- to 9-year-olds is ≥ 5%, ≥ 1 additional MDA rounds are recommended before resurvey. Impact survey costs, and the proportion of impact surveys returning TF prevalence ≥ 5% (the failure rate or, less pejoratively, the MDA continuation rate), therefore influence the cost of eliminating trachoma. We modeled, for illustrative EU sizes, the financial cost of undertaking MDA with and without conducting impact surveys. As an example, we retrospectively assessed how conducting impact surveys affected costs in the United Republic of Tanzania for 2017–2018. For EUs containing 100,000 people, the median (interquartile range) cost of continuing MDA without doing impact surveys is USD 28,957 (17,581–36,197) per EU per year, whereas continuing MDA solely where indicated by impact survey results costs USD 17,564 (12,158–21,694). If the mean EU population is 100,000, then continuing MDA without impact surveys becomes advantageous in financial cost terms only when the continuation rate exceeds 71%. For the United Republic of Tanzania in 2017–2018, doing impact surveys saved enough money to provide MDA for > 1,000,000 people. Although trachoma impact surveys have a nontrivial cost, they generally save money, providing EUs have > 50,000 inhabitants, the continuation rate is not excessive, and they generate reliable data. If all EUs pass their impact surveys, then we have waited too long to do them.
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Affiliation(s)
- Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Pamela J Hooper
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | - Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Upendo J Mwingira
- Neglected Tropical Disease Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Ana Bakhtiari
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | | | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Iain Jones
- Sightsavers, Haywards Heath, United Kingdom
| | - George Kabona
- Neglected Tropical Disease Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Amir B Kello
- Expanded Special Project for Elimination of Neglected Tropical Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Tom Millar
- Sightsavers, Haywards Heath, United Kingdom
| | - Aryc W Mosher
- United States Agency for International Development, Washington, District of Columbia
| | | | - Andreas Nshala
- Department of International Maternal and Child Health, Faculty of Medicine and Pharmacy, University of Uppsala, Uppsala, Sweden.,IMA World Health, Dar es Salaam, United Republic of Tanzania
| | - Kristen Renneker
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | | | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mwelecele N Malecela
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Ilechie A, Wanye S, Abraham CH, Sarpong JB, Abu E, Abokyi S, Morny E, Mensah B, Amoako MO, Fosu-Gyeabour S. Inter-regional trends in causes of childhood blindness and low vision in Ghana. Clin Exp Optom 2020; 103:684-692. [PMID: 31916287 DOI: 10.1111/cxo.13041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Inter-regional trends of visual loss in most developing countries remain largely unknown. We compared the causes of childhood blindness among children attending blind schools in the northern (one school) and southern (two schools) regions of Ghana and assessed their need for spectacles and low-vision devices. METHODS Using a standardised methodology, children were examined by an ophthalmologist and optometrists in each location. Causes of visual loss were classified anatomically and by time of onset, and avoidable causes identified. Children identified with functional low vision were assessed and provided with low-vision devices. RESULTS A total of 252 children under 16 years of age were examined in the schools. The overall prevalence of total blindness was 73 (29.0 per cent), with similar proportions (p = 0.87) in the north (29 [28.4 per cent]) and south (44 [29.3 per cent]); 92 (36.5 per cent) had functional low vision. Two children improved with spectacles and 35 benefited from low-vision devices. Corneal scarring was significantly (p = 0.045) more prevalent in southern Ghana (n = 150) than in the north (n = 102), responsible for visual loss in 36 (24.0 per cent, 95% CI 17.2-30.8 per cent) and 14 (13.7 per cent, 95% CI 7.0-20.4 per cent) cases, respectively. No significant difference (p = 0.321) was observed in the prevalence of cataract between northern (28: 27.5 per cent, 95% CI 18.3-36.2 per cent) and southern Ghana (33: 22.0 per cent, 95% CI 15.4-28.6 per cent). Over 87 per cent of children had 'avoidable' causes of visual loss, with a higher proportion being treatable (124: 49.2 per cent) than preventable (96: 38 per cent). CONCLUSION Cataract was the major cause of visual loss in the overall population. The south had a higher proportion of corneal scarring and late-onset blindness compared with the north. More than one-third of blindness in blind schools in Ghana could have been prevented by primary care interventions and nearly half could have been treated surgically to prevent visual loss. Two in five children in blind schools in Ghana could benefit from optical intervention.
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Affiliation(s)
- Alex Ilechie
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Seth Wanye
- Ophthalmology Department, Tamale Teaching Hospital, Tamale, Ghana
| | - Carl H Abraham
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Josiah B Sarpong
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Abu
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Abokyi
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Enyam Morny
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Bismark Mensah
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Maclean O Amoako
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Simon Fosu-Gyeabour
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
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Senyonjo L, Aboe A, Bailey R, Agyemang D, Marfo B, Wanye S, Schmidt E, Addy J, Blanchet K. Operational adaptations of the trachoma pre-validation surveillance strategy employed in Ghana: a qualitative assessment of successes and challenges. Infect Dis Poverty 2019; 8:78. [PMID: 31455431 PMCID: PMC6712645 DOI: 10.1186/s40249-019-0585-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2009 Ghana began to design a trachoma pre-validation surveillance plan, based on then-current WHO recommendations. The plan aimed to identify active trachoma resurgence and identify and manage trichiasis cases, through both active and passive surveillance approaches. This paper outlines and reviews the adaptations made by Ghana between 2011 and 2016. The assessment will provide a learning opportunity for a number of countries as they progress towards elimination status. METHODS A mixed methods approach was taken, comprising in-depth interviews and documents review. Between January and April 2016, 20 in-depth interviews were conducted with persons involved in the operationalisation of the trachoma surveillance system from across all levels of the health system. A three-tier thematic coding framework was developed using a primarily inductive approach but also allowed for a more iterative approach, which drew on aspects of grounded theory. RESULTS During the operationalisation of the Ghana surveillance plan there were a number of adaptations (as compared to the WHO recommendations), these included: (i) Inclusion of surveillance of active trachoma in the passive surveillance approach, as compared to trichiasis alone. Issues with case identification, challenges in implementation coverage and a non-specific reporting structure hampered effectiveness; (ii) Random selection and increase in number of sites selected for the active surveillance component. This likely lacked the spatiotemporal power to be able to identify recrudescence in a timely manner; (iii) Targeted trichiasis door-to-door case searches, led by ophthalmic nurses. An effective methodology to identify trichiasis cases but resource intensive; (iv) A buddy system between ophthalmic nurses to support technical skills in an elimination setting where it is difficult to attain diagnostic and surgical skills, due to a lack of cases. The strategy did not take into account the loss of proficiency within experienced personnel. CONCLUSIONS Ghana developed a comprehensive surveillance system that exceeded the WHO recommendations but issues with sensitivity and specificity likely led to an inefficient use of resources. Improved targeted surveillance strategies for identification of recrudescence and trichiasis case searches, need to be evaluated. Strategies must address the contextual changes that arise because of transmission decline, such as loss of surgical skills.
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Affiliation(s)
- Laura Senyonjo
- Research team, Sightsavers, Haywards Heath, UK. .,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Robin Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Karl Blanchet
- Department of Global health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Assessing the Progress towards Achieving "VISION 2020: The Right to Sight" Initiative in Ghana. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2019; 2019:3813298. [PMID: 31428165 PMCID: PMC6679876 DOI: 10.1155/2019/3813298] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/02/2019] [Indexed: 12/03/2022]
Abstract
Purpose The aim of this study was to analyse eye health delivery in Ghana and examine the progress towards achieving VISION 2020 indicator targets. Methods This descriptive cross-sectional study was conducted between October 2017 and May 2018. It used a mixed method approach including desk-based reviews, a questionnaire-based survey of eye facilities in Ghana, and interviews with eye health system stakeholders to collect information on eye health delivery in facilities owned by the Ghana Health Service (GHS), quasigovernmental bodies (security agencies), and Christian Association of Ghana (CHAG). The information was benchmarked against the World Health Organization (WHO) targets for achieving the goals of VISION 2020. Results The magnitude of blindness and moderate to severe visual impairment (without pinhole) was 0.9% and 3.0%, respectively. The number of ophthalmologists available at the country level was 80.6% of the VISION 2020 target with optometrists and ophthalmic nurses exceeding targets for VISION 2020. The distribution of human resources was heavily skewed towards two out of the 10 regions in Ghana. Cataract surgical rate was low and met 25% of the WHO target. Basic equipment for refraction was available in the majority of facilities; however, there was a general lack of specialised eye care equipment across the country. Comparatively, CHAG facilities were better equipped than GHS facilities at the same level. Conclusion The Government of Ghana should revitalize the goals of VISION 2020 beyond the year 2020 and spearhead a concerted effort to ensure equitable distribution of human and infrastructural resources across the country.
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Hotez PJ, Biritwum NK, Fenwick A, Molyneux DH, Sachs JD. Ghana: Accelerating neglected tropical disease control in a setting of economic development. PLoS Negl Trop Dis 2019; 13:e0007005. [PMID: 30653493 PMCID: PMC6336233 DOI: 10.1371/journal.pntd.0007005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- James A Baker III Institute of Public Policy, Rice University, Houston, Texas, United States of America
- Scowcroft Institute of International Affairs, Bush School of Government and Public Policy, Texas A&M University, College Station, Texas, United States of America
- * E-mail: (PJH); (N-KB); (AF); (DHM); (JDS)
| | - Nana-Kwadwo Biritwum
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
- Ghana Health Service, Accra, Ghana
- * E-mail: (PJH); (N-KB); (AF); (DHM); (JDS)
| | - Alan Fenwick
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
- * E-mail: (PJH); (N-KB); (AF); (DHM); (JDS)
| | - David H. Molyneux
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (PJH); (N-KB); (AF); (DHM); (JDS)
| | - Jeffrey D. Sachs
- Center for Sustainable Development, Earth Institute, Columbia University, New York, New York, United States of America
- * E-mail: (PJH); (N-KB); (AF); (DHM); (JDS)
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Senyonjo LG, Debrah O, Martin DL, Asante-Poku A, Migchelsen SJ, Gwyn S, deSouza DK, Solomon AW, Agyemang D, Biritwum-Kwadwo N, Marfo B, Bakajika D, Mensah EO, Aboe A, Koroma J, Addy J, Bailey R. Serological and PCR-based markers of ocular Chlamydia trachomatis transmission in northern Ghana after elimination of trachoma as a public health problem. PLoS Negl Trop Dis 2018; 12:e0007027. [PMID: 30550537 PMCID: PMC6310292 DOI: 10.1371/journal.pntd.0007027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/28/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Validation of elimination of trachoma as a public health problem is based on clinical indicators, using the WHO simplified grading system. Chlamydia trachomatis (Ct) infection and anti-Ct antibody responses (anti-Pgp3) have both been evaluated as alternative indicators in settings with varying levels of trachoma. There is a need to evaluate the feasibility of using tests for Ct infection and anti-Pgp3 antibodies at scale in a trachoma-endemic country and to establish the added value of the data generated for understanding transmission dynamics in the peri-elimination setting. METHODOLOGY/PRINCIPAL FINDINGS Dried blood spots for serological testing and ocular swabs for Ct infection testing (taken from children aged 1-9 years) were integrated into the pre-validation trachoma surveys conducted in the Northern and Upper West regions of Ghana in 2015 and 2016. Ct infection was detected using the GeneXpert PCR platform and the presence of anti-Pgp3 antibodies was detected using both the ELISA assay and multiplex bead array (MBA). The overall mean cluster-summarised TF prevalence (the clinical indicator) was 0.8% (95% CI: 0.6-1.0) and Ct infection prevalence was 0.04% (95%CI: 0.00-0.12). Anti-Pgp3 seroprevalence using the ELISA was 5.5% (95% CI: 4.8-6.3) compared to 4.3% (95%CI: 3.7-4.9) using the MBA. There was strong evidence from both assays that seropositivity increased with age (p<0.001), although the seroconversion rate was estimated to be very low (between 1.2 to 1.3 yearly events per 100 children). CONCLUSIONS/SIGNIFICANCE Infection and serological data provide useful information to aid in understanding Ct transmission dynamics. Elimination of trachoma as a public health problem does not equate to the absence of ocular Ct infection nor cessation in acquisition of anti-Ct antibodies.
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Affiliation(s)
- Laura G. Senyonjo
- Research Department, Sightsavers UK, Haywards Heath, United Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oscar Debrah
- Eye Care Unit, Ghana Health Service, Accra, Ghana
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adwoa Asante-Poku
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Stephanie J. Migchelsen
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dzeidzom K. deSouza
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Benjamin Marfo
- Department of Neglected Tropical Diseases, Ghana Health Service, Accra, Ghana
| | | | | | | | | | - James Addy
- Eye Care Unit, Ghana Health Service, Accra, Ghana
| | - Robin Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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